There are many invasive techniques available for reducing wrinkles. They are all effective to the degree that they change the nature of aging collagen, they stretch the skin, fill in the depressions in the skin, or they paralyze muscles that cause the skin to crease. Below are the mainstream procedural options to treat wrinkle:
Botox: Injection of botulinum toxin, the muscle poison, can paralyze muscles that produce the “frown lines” on the forehead, fine lines around the eyes, and other wrinkles. Improvement lasts several months and must be repeated to sustain improvement. Injected properly, Botox is quite safe; the muscle poison does not spread through the body to do damage elsewhere.
Fillers: Fillers are injected into the skin to increase volume and flatten wrinkles and folds. In the past, the most popular filler was collagen. More recently, new filler substances such as hyaluronic acid (Restylane, Juvederm) and calcium hydroxylapatite (Radiesse), lactic acid (Sculptra), and autologous fat transplants are being used because their effect can last six to nine months or even longer.
Glycolic acid peels: These superficial peels can make a very slight difference in the intensity of fine wrinkles.
Deeper peels: These peels use ingredients like salicylic acid and trichloroacetic acid and penetrate somewhat deeper into the skin. Deeper peels do a better job of smoothing fine lines. The deeper the peel, however, the greater the risk of side effects such as long-lasting pigment changes (changes in the color of the skin) and scarring. Such peels may require anesthesia. Mild sedation helps ease short-term but fairly intense discomfort.
Microdermabrasion: This refers to “sanding the skin” with a machine containing silica or aluminum crystals; many estheticians offer this service, usually in “packages” of six or seven sessions. Microdermabrasion does not change skin anatomy, though it may make the face feel smoother. Cosmetic products marketed as “home microdermabrasion” are just mild exfoliants — harmless but not likely to produce any meaningful change in wrinkles.
Dermabrasion: This is a true surgical procedure, often performed under general anesthesia. The treating physician uses a rotating instrument to sand the skin down. Depending a great deal on the skill and experience of the operator, dermabrasion can result in excellent improvement but can also produce significant side effects, including scarring and permanent changes in skin color.
Laser resurfacing: Using instruments such as the carbon dioxide and erbium lasers, physicians can achieve results similar to those of dermabrasion with greater reliability and precision. The laser is passed several times over the area to be treated until the damage reaches the middle of the dermis, the skin’s second layer. This helps stimulate the body’s natural collagen synthesis, which plumps up sagging skin and wrinkles. Some dermatologists perform laser resurfacing under “conscious sedation,” in which the patient remains awake and receives intravenous medications to calm and ease pain. This sedation is combined with the application of topical anesthetic creams such as EMLA, as well as injections of local anesthetics like lidocaine. Procedures may need to be repeated to maximize improvement. Skin takes a long time to heal after resurfacing. This procedure can cause permanent pigment changes and scarring.
Fractional resurfacing: Newer lasers work through a modification of traditional laser resurfacing. Treatments affect not the whole skin but instead only evenly spaced spots surrounded by undamaged skin. Healing is much faster than traditional resurfacing, with less “downtime” afterward. Several treatments are needed to achieve full benefit.
Non-ablative laser resurfacing: Newer lasers attempt to stimulate collagen synthesis under the skin without damaging the epidermis. Studies and clinical experience suggest that such procedures can improve fine wrinkles, though not as much as laser resurfacing. Several treatments may be necessary. These procedures are almost painless and there is little or no redness, peeling, or downtime afterward.
Heat and radiofrequency: Another variation of noninvasive facial rejuvenation is to heat tissue using radiofrequency devices and infrared light sources. Techniques are still being developed but results to date suggest that such treatments are safe and can produce visible and lasting improvement, though not as much as surgical techniques like facelifts (rhytidectomy).
Plastic surgical procedures: Surgical facelifts, brow lifts, and similar operations can be very helpful for selected patients.
Anyone considering any of the cosmetic procedures should be sure to consult doctors who have experience in one or several of these techniques. Patients should fully inform themselves about the risks and potential benefits of the procedure they are considering before going forward.